The effectiveness of instrument-assisted soft tissue mobilization in athletes, participants without extremity or spinal conditions, and individuals with upper extremity, lower extremity and spinal conditions: a systematic review

Key points

1. 01IASTM uses special tools (Graston, Ergon, Astym, and others) to scrape or rub soft tissue, and is widely used in physical therapy, chiropractic, sports rehabilitation, and athletic training.
2. 02When IASTM was added on top of other treatments, most trials found no clinically important difference compared with the other treatments alone.
3. 03When IASTM was compared with no treatment, most trials again found no clinically important difference.
4. 04The only signal of benefit was a small effect on muscle performance in physically active people, and it was very small.
5. 05The review authors graded the evidence using formal risk-of-bias and GRADE tools, which earlier reviews of the same trials had not done.

How it was conducted

Design

Systematic review of randomized controlled trials (PRISMA and Cochrane guidelines), registered as CRD42018092094

Data sources

MEDLINE, EMBASE, CINAHL, and PEDro searched from January 1998 to March 2018, plus trial registries and reference lists

Participants

People without extremity or spinal conditions, athletes, and people with upper extremity, lower extremity, or spinal conditions

Comparisons

IASTM (any brand) vs other active treatment, placebo or sham, or no-treatment control

Outcomes

Pain, disability and function, range of motion, grip strength, pressure sensitivity, and muscle performance

Appraisal

Two independent reviewers extracted data, rated risk of bias with the Cochrane tool, and rated evidence quality with GRADE

What they found

• Of 9 trials comparing IASTM added to other treatments vs other treatments alone, 6 reported no clinically important differences between groups.
• 2 trials reported clinically important differences favoring the other-treatment (without IASTM) group.
• Of 6 trials comparing IASTM vs no-treatment control, 3 reported no clinically important differences between groups.
• IASTM showed only small effects (standardized mean difference range 0.03 to 0.24) for improving muscle performance in physically active individuals versus a no-treatment group.

Limitations

• Trials were not pooled into a single quantitative meta-analysis, so findings are summarized trial by trial rather than as one overall effect estimate.
• The included trials were limited in number and spanned mixed populations and conditions, which limits how strongly conclusions can be drawn.
• Only English-language randomized trials were included, excluding non-English studies, conference abstracts, and posters.
• Where benefit appeared, it was confined to a small effect on one outcome (muscle performance) in healthy active people.

Why it matters

For patients

If you are considering IASTM for pain or stiffness, current evidence suggests it is unlikely to add meaningful benefit beyond other treatments.

For clinicians

There is no strong basis to choose IASTM over other active treatments for pain, function, or range of motion, and in some trials the comparison treatment did better.

For readers

This review reframes earlier IASTM reviews by judging clinical relevance and evidence quality rather than relying on p-values, and concludes the case for IASTM is weak.